Faqs

A high index of suspicion needs to be maintained if there is history of difficult labour, low birth weight, need of NICU care. A normal baby should have good neck holding by 3 months, sitting by 6 months and walking by 1.5 years. Any child with deviations from these milestone should be investigated

Cerebral palsy cannot be totally prevented as there are multiple causes. Good maternal and child care can reduce the incidence.

Physiotherapy and medical management in early stages. Surgery at a later stage

No. There is some injury to brain and hence some deficit always remains

As soon as a delay in milestone is observed physiotherapy should be started

A physiotherapist improves the development of large muscles of the body which helps the child to stand and walk. An occupational therapist help in development of fine motor skills and activities of daily living like eating, writing, wearing clothes

Ideally it should be done life long, minimum till the height of the child is growing (around 15-17 years)

Early intervention takes advantage of ongoing process of myelination and neural plasticity of brain 6months to 3 years. Valuable time is lost in “ wait & watch policy” attitude adopted by parents, grand parents and even medical specialists

The approach is unique by the virtue that it looks at the child as a ‘whole’. That means the treatment is directed not only towards physical independence, but it also targets child’s emotional, social, sensory, perceptual aspects so that he or she becomes an active member of the society and can fulfil his duties like any other individual. Treatment by the approach does not stop at achieving physical improvement; but assures that the child is able to use the same to accomplish his age- appropriate roles.

Handedness is usually decided around 2 years of age. Till then a child should use both hands equally. If one hand is weak then the child learns to use the better hand and hence it is very difficult to break the habit at a later stage. The child should however be encouraged to use the weak hand otherwise the weakness and wasting will progress.

Specially designed spoons and forks with long handles or straps are available. Use of Velcro straps instead of buttons are some of the examples. Use of books with pictures are also good tools for communication.

Children with poor sitting balance should be given a belt to support them and help them sit upright. The child hence learns to understand the surroundings and becomes more interactive.

Wheelchairs, walkers, elbow crutches, tripod sticks are some of the mobility devices to be used according to the mobility of the child.

A wheelchair will increase the mobility of the child and will make him independent. His social interactions and interactions with the surroundings will improve and hence will bring the overall development of the child.

Dislocated hips tend to be painful in later life and also impair sitting and toilet care. Hence operative reduction is the treatment of choice.

From an early age scissoring posture and ‘W’ sitting should be avoided. Hip radiographs should be performed every year to diagnose early dislocation.

Consult your doctor. The child will need radiographs and use of belts. In severe cases surgery may be required.

The child has tight hamstring muscles and weak quadriceps muscles. Physiotherapy, strengthening exercises and surgery may be required

His tendoachillis muscle (heel cord) is tight. It needs regular physiotherapy, plasters, botulinum toxin A treatment or surgery.

They are seen in most of the children with cerebral palsy. A tight heel cord leads to midfoot break. Ankle Foot Orthosis should be used to prevent progression. Surgery of the foot may be required.

Yes. If surgery is advised by your doctor then it must be performed. It will increase the mobility of the child.

Muscle lengthening surgery should be avoided before 7 years of age. In some conditions however surgery may be required at an earlier age.

Ideally Physiotherapy will be required life long or atleast till the height of the child is growing.

Generalised spasticity can be reduced by oral medications like tab. Baclofen. Localised spasticity can be reduced bu Botulinum Toxin A, Baclofen pump, Selective dorsal rhizotomy or by specific tendon lengthening procedures.

Botulinum toxin is a protein produced by the bacterium Clostridium botulinum. It acts on the nerve terminals and prevents release of Acetylcholine, which in turn causes temporary paralysis of muscles. It is commercially available as Botox, Dysport.

It causes relaxation of the spastic muscles and improves joint range of motion. This will help the physiotherapist to train the opposite group of muscles and trunk muscles. This will ultimately result in improvement in gait and function of the child

The duration of action is 3-6 months. Results in the injected muscle can be prolonged by use of splints and physiotherapy

It can be given 5-6 times with a minimum gap of 4-6 months

There are no know major side effects. It causes some weakness in muscles which is reversible. Other side effect could be allergic reaction

In children with minor involvement and single muscle involvement surgery can be prevented. However repeated injections may be required. In all other cases surgery may be required once the child grows older.

In India the cost varies from Rs. 9,000 for 50 IU and Rs. 17,000 for 100 IU. How can a parent diagnose that the child is not able to hear? Answer: A child between 0-3 months of age should startles to loud noise, awakens to sounds, blinks or widens eyes in response (reflex) to noises .

In about 70 percent of cases there is no known cause. But we do know that recurring seizures can be related to: Birth problems – premature delivery, birth asphyxia (lack of oxygen when baby does not cry immediately after birth) or birth defects affecting baby’s brain Maternal injury, infection or systemic illness affecting the developing brain of the fetus during pregnancy. Head trauma: especially from automobile accidents, falls and blows, gunshot wounds or sports accidents. The more severe the injury, the greater the risk of developing epilepsy. Infection–meningitis, viral encephalitis, and less frequently mumps, measles, diphtheria and others.

Most seizure disorders can be controlled partly or completely by: Anti-convulsive medication -85-90% Surgery -5-10% Special Ketogenic Diet

Stay calm- don’t try to restrain or revive the person. If the person is seated, help ease him/her to the floor/ safe place. Take charge of the situation where crowded and do not allow people to crowd around the person. Remove hazards such as hard or sharp objects that could cause injury if the person falls or knocks against them. Don’t move the person unless the area is clearly dangerous, such as a busy street. Loosen tight clothing and remove glasses. Protect airways by gently turning the person on one side so any fluid in the mouth can drain safely. Never try to force something into the person’s mouth! –especially keys, hard objects etc. Many people offer Onion or shoe to smell or keep Iron object in the person’s hand which is scientifically baseless. Don’t call an ambulance/doctor/paramaedical staff , unless the seizure lasts more than five minutes, or is immediately followed by another one, or if the person is pregnant, ill, or injured. When the seizure ends, let the person rest or sleep. Be calm and reassuring because the person may feel disoriented or embarrassed.

Generally, children utter their first meaningful, spontaneous, single words around 12 to 14 months of age, though the upper limit of this milestone can be extended to nearly 24 months. However, it is advisable to first consult a developmental paediatrician by 15 months of age or earlier, in case of any doubt. The important point to remember here is that a child will begin to speak only after a certain minimum amount of comprehension [understanding] capacity has developed, as comprehension precedes expression. If a child is delayed in speech and language, a paediatrician or speech therapist would search for reasons related to a possible hearing impairment, mental challenge, autistic spectrum disorder, visual impairment, cerebral palsy, multiple special needs, or other syndromes. The doctor may refer the child for different tests, before coming to any definite conclusion. In case medical or surgical intervention is required, the doctor would make the necessary suggestions. Simultaneously, the child would be referred for therapies [speech and language, physio, occupational, remedial education, behavioural], depending on the age and special need/s of the child. However, some children may display speech and language delay without having any special needs. Here, generally, the delay may be linked to deficiency in the quality and quantity of stimulation the child is exposed to. At times, use of multiple languages in the child’s environment may be a major factor for certain children.

No child begins speaking in an absolutely clear way. As part and parcel of natural speech development, speech may be unclear [ex. “tat” for cat, “umlebra” for umbrella, “fo” for fox], or there may be natural repetitions [ex. I want to gggo out]. A therapist would judge whether the speech is within range for age, or whether direct or indirect interventions are required. The therapist would also take a detailed case-history to ascertain whether the child may have special needs, a tongue-tie, poor quality environmental input, or other issues. Accordingly, referrals would be made, parental counselling would begin, or therapeutic intervention would commence.

Actually, more appropriate terms would be “communication therapy” or “speech and language therapy”. Our job is to help the child/adult communicate his/her needs wants, ideas, fears and thoughts, as per the capacity of the individual. Speech is only one method of communication, and of course, the most socially-acceptable one. However, what happens to a child or adult, who, for some reason, has nil or limited speech? We need to help them to communicate using alternative and augmentative methods. These would include use of gestures, pointing [with hand/ finger/ eyes/ foot], body language, facial expressions, voice intonations, picture or word communication boards/ books, alphabet boards, or technology-assisted devices, among others. The methods chosen would depend on the physical & mental capacities of the individual. If speech is affected in terms of clarity, fluency, voice characteristics or any other area, speech therapy would be given. Further, a speech therapist also deals with improving reading, writing and number skills. Problems related to chewing and/or swallowing are also looked into. Team efforts are often required. Doctors [medical or surgical specialists], speech and language therapists, physiotherapists, occupational therapists, psychologists, remedial educators, parents and teachers are among the few who may be required to work together.

This is a very vast topic, and cannot be fully covered here. Basically, a child needs a very stimulating environment in order to develop comprehension and communication. Lots of inter-action is required, using songs, poems, stories, toys, art, craft, outings, out-door activities, — the list is endless. Giving of one’s personal time is extremely essential, rather than depending on relatives, day-care centres or maids. Not only quantity of input, but also quality, needs to be considered. Park-play, and a chance to mix with children of the same age-group, are also important. A happy, healthy home-environment for the child will go a long way in helping speech and language development. Further, in case of any doubt, please contact a developmental paediatrician as early as possible.

This would depend on several factors. Depending on the age of the child and the severity of the condition, therapy would be direct or indirect. For very small children, initially more time would be spent with the parents, guiding them how to interact with the child, and how to increase the child’s comprehension skills. For older children, therapy may be directly given to the child, along with certain sessions where parents are counselled separately. Initially, two sessions [minimum] may be required per week. However, therapy will not help, unless all suggestions are practically implemented by the parents at home. After all, communication is a 24-hour process.

Developmental Delay is a term used, when children have not reached milestones they are expected to achieve by their chronological age. For example, if the normal range for learning to walk is between 12 and 15 months, and a 20-month-old child has still not begun walking, this would be considered a developmental delay. Developmental delays can occur in all five areas of development (gross motor, fine motor, speech, social interaction and activities of daily living) or may just happen in one or more of those areas. Additionally, Growth in each area of development is related to growth in the other areas. So if there is a difficulty in one area (e.g., speech and language), it is likely to influence development in other areas (e.g., social and emotional).

Before four years if a child has delay in more than two areas of development it is called global developmental delay. Generally doctors do not make a diagnosis of mental retardation until after 4 years of age unless delay is severe, however, because standardized tests for children younger than 3 measure present cognitive development rather than intelligence and are less predictive of the future

This is a clinical estimation of the child’s performance. It is used upto 2 ½ years of age. Developmental quotient (DQ) is expressed as a formula: DQ= Developmental age/ Chronological age x 100. For e.g. if a child who is 30 months old on testing seems to have an average developmental age of 15 months, the DQ is 15/30X 100= 50.

Intelligence is defined as a composite of maturity of motor, adaptive, language and personal social behavior. Intelligence tests calculate an IQ or intelligence quotient that is the index of the intellectual brightness of the child. IQ= Mental age (MA)/ Chronological age (CA) X 100. Types of tests include 1. Wechsler Intelligence scale for children –III for children age 6-17 years. This includes verbal scale and performance scale. 2. Stanford Binet, the Indian adaptation being the Binet Kamat test of intelligence. Used in age group of 2-23 years. Score: 85-100 =normal 75-85= borderline 55-75= mild retardation 35-55= moderate retardation 20-35= severe retardation <20= profound mental retardation.

Currently there are no medications available to improve intelligence scores. An IQ assesses child’s strengths and weaknesses. The child’s performance can be improved by early intervention, ample appropriate stimulation, love support by the family, school environment and help from specific interventions as in therapies for specific areas of help like speech therapy for speech delay, occupational therapy for poor hand skills, paly therapy for behavior disorders. In some conditions like attention difficulties, medications for hyperactivity can help improve focus.

In a child with irritability, one needs to assess the child in all areas of Development. Upto 3 months of age irritability could be due to difficulties with initiation of feeding, poor suck-swallow coordination, reflux or incorrect feeding techniques, colic in a relatively healthy looking baby. But if irritability is associated with fever and refusal of feeds it could be a sign of infection, neurological conditions and a visit to a Pediatrician becomes mandatory to look for etiology

Noncompliance or not listening is normally defined as a child failing to comply with a parental or teacher command (i.e., request to initiate a specific behavior) within a time period of 15 seconds. Examples of noncompliant/defiant behaviors include, whining, yelling, screaming, swearing, temper tantrums, throwing objects, and failing to complete daily routines. It is a normal part of the developmental process, particularly in preschool-age children and adolescents. At other times, however, noncompliance is developmentally inappropriate and requires effective intervention Noncompliance has been frequently associated with the following behavioral disorders: ADHD, Oppositional Defiant Disorder. The most likely function of noncompliant behavior is access to positive attention and escape/avoidance of undesirable tasks or commands. The most effective treatment approach for reducing noncompliant behaviors involves parent training on more effective behavioral management strategies